Several of the NHS Commissioning Board’s local arms will have enormous budgets - dwarfing those of most clinical commissioning groups - HSJ estimates show.
Ten of the board’s 25 local area teams will commission specialised services for their whole region.
HSJ has estimated budgets for all the teams - which will also commission primary care, some public health services and military and prison health - based on previous Department of Health analysis of primary care trusts’ spending.
The commissioning board confirmed to HSJ which 10 groups would be in charge of specialised services for their region. They will have the largest budgets (see table below). They have been dubbed “enhanced” LATs by senior commissioners.
The largest annual budget by some distance is £4bn for London, which has a single LAT, directed by Simon Weldon, currently NHS North West London director of operations.
The second largest is Birmingham and the Black Country, with a budget of £1.5bn. Its director will be Wendy Saviour, who was previously NHS East Midlands director of commissioning.
HSJ’s estimates suggest the LATs with the smallest budgets will be Bath, Gloucestershire, Swindon and Wiltshire, with £325m, and Durham, Darlington and Tees, with £323m.
In contrast, CCG budgets are expected to range from about £70m for NHS Corby CCG to about £800m-£900m for the biggest groups - NHS Cambridgeshire and Peterborough CCG and NHS North, East and West Devon CCG. It is estimated the average CCG budget will be about £290m - smaller than that of all the commissioning board’s LATs.
The analysis demonstrates the huge and direct influence the “enhanced” LATs will have on their local providers. The board will contribute much of providers’ income, particularly for specialist and large tertiary hospital trusts.
LAT directors have been told they have an important role in planning strategy for their area and in service reconfiguration. The “enhanced” LATs are also likely to host clinical senates and networks, which will advise on regional service planning.
Final budgets for when CCGs and the commissioning board take on their full roles in April next year are likely to be slightly different from current estimates.
The Department of Health will recalculate “baseline” budgets based on new information from PCTs. In addition, a review is being carried out of which activities fall under the definition of specialised services, and will therefore be commissioned by the board. It is expected to increase the services which qualify.
One senior commissioner involved in developing LATs acknowledged there was a danger their huge role could stifle CCGs, and said there was a “balance to be struck between support and development and holding them [CCGs] to account”.
The source said: “People [involved in LATs] are really committed to giving CCGs the headroom to take the lead where they can, but that doesn’t mean we can sit back watching while we carry on letting people die from strokes where they don’t need to [if CCGs are not leading service redesign].”